Abdominal Pain in Malaria

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QUESTION

What is the cause of abdominal pain in malaria?

ANSWER

Often, abdominal pain in malaria occurs in the early stages of malaria infection (first week or so) and can be caused by the rapid enlargement of the liver and spleen as they become inflamed. During malaria infection, and particularly that with Plasmodium falciparum, the most deadly and severe form of malaria, large numbers of red blood cell become sequestered in the liver and the spleen (as well as other major organs). A danger is that if the spleen becomes too enlarged, it may rupture, causing massive internal bleeding which can be incredibly dangerous to the patient, and  lethal without immediate medical attention.

Classification of Malaria Parasite

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QUESTION

What is the classification of malaria?

ANSWER

Malaria is caused by a single celled protist of the genus Plasmodium. This genus is part of a Phylum of single-celled protist organisms called Apicomplexa.

The Apicomplexans mostly posses an organ called an apicoplast, which is part of an apical structure designed to aid entry into a host cell. The Apicomplexa is split into two Classes, of which Plasmodium belongs to the Aconoidasida (lacking a structure called a conoid, which is like a set of microtubules), and then to the Order Haemosporidia, which contains parasites which invade red blood cells. Within this Order, Plasmodium belongs to the Family Plasmodiidae, which all share numerous characteristics, including asexual reproduction in a vertebrate host and sexual reproduction in a definitive host (a mosquito, in the case of the Plasmodium species that infect all mammals, including humans).

In the case of human malarias, the definitive host is often referred to as the vector. The family contains about twelve genera, of which one is Plasmodium, which itself is now often divided up into numerous sub-genera, and then again into hundreds of different species, of which five infect humans (P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi).

Causes of Malaria

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QUESTION

What are the causes of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. 

Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

Malaria Transmission

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QUESTION

How is malaria transmitted?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. 

Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

How Long Does it Take for Malaria to Affect the Body?

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QUESTION

How long does malaria take to actually affect you?

ANSWER

When you are bitten by a mosquito that is infected with the parasites that cause malaria, some of the parasites enter your blood stream in the mosquito’s saliva. After that, it will take at least one week, and usually between two and four weeks, before you start to feel the symptoms of the disease. This is because the parasite first goes to the liver, where it infects liver cells and undergoes replication. These cells mature into a form called merozoites, which then re-enter the blood stream, and start to infect red blood cells. The stage in the liver is not symptomatic for the patient, and is known as the pre-patent stage; once the merozoites start infecting and killing red blood cells, the patient will begin to feel sick, and the infection is said to have become patent.

Malaria Life Cycle

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QUESTION

What is the life cycle of malaria?

ANSWER

Malaria is caused by a single celled organism in the genus Plasmodium. Five species of Plasmodium infect humans, but all follow a very similar life cycle, including two separate cycles of asexual reproduction in the human host (one in the liver, called the exo-erythrocytic cycle, and one in the blood, and specifically inside red blood cells, known as the erythrocytic cycle) and a sexual reproductive stage inside the mosquito definitive host (usually called the “vector”). A schematic of the full life cycle is below, courtesy of the CDC (www.cdc.gov).

malaria life cycle CDC

Schematic of the malaria life cycle, courtesy of CDC (www.cdc.gov)

Malaria Parasite Classification

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QUESTION

What is the classification of malaria?

ANSWER

Malaria is caused by a single celled protist of the genus Plasmodium. This genus is part of a Phylum of single-celled protist organisms called Apicomplexa.

The Apicomplexans mostly posses an organ called an apicoplast, which is part of an apical structure designed to aid entry into a host cell. The Apicomplexa is split into two Classes, of which Plasmodium belongs to the Aconoidasida (lacking a structure called a conoid, which is like a set of microtubules), and then to the Order Haemosporidia, which contains parasites which invade red blood cells. Within this Order, Plasmodium belongs to the Family Plasmodiidae, which all share numerous characteristics, including asexual reproduction in a vertebrate host and sexual reproduction in a definitive host (a mosquito, in the case of the Plasmodium species that infect all mammals, including humans).

In the case of human malarias, the definitive host is often referred to as the vector. The family contains about twelve genera, of which one is Plasmodium, which itself is now often divided up into numerous sub-genera, and then again into hundreds of different species, of which five infect humans (P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi).

Malaria Infectious?

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QUESTION

Is malaria infectious?

ANSWER

Yes, malaria is considered an infectious disease, though it is very rarely transmitted directly between people, and virtually all of the time must be transmitted via the bite of a mosquito (of the genus Anopheles).

Because part of the life cycle of malaria occurs in red blood cells in the human host, if sufficient amounts of blood are shared between people, for example during a blood transfusion, malaria can also pass between them this way, though screening measures reduce the likelihood of this occurring. Similarly, an earlier part of the life cycle occurs in the liver, so transplant of this organ can also result in transmission.

Finally, malaria is able to pass through the placenta, and so can be transmitted from a mother to her unborn child in this way, or also via blood during childbirth. When a baby contracts malaria from each mother, either via the placenta or during childbirth, it is known as “congenital” malaria.

Life Cycle of Malaria

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QUESTION

Why does the malaria parasite first enter the liver?

ANSWER

The malaria parasite enters the liver in order to transform from a sporozoite (which can infect liver cells) to a merozoite, which is capable of infecting red blood cells. Both stages also include a proliferation step, but in the blood, the merozoites are also able to differentiate into gametocytes, which are then taken back up by a mosquito during a blood meal, allowing the malaria parasite to continue its life cycle. If the red blood cell stage were first, followed by the liver, then it would be much harder for the gametocytes to be able to reach a new mosquito host, unless they were to enter the blood a third time.

The blood is also a difficult place for a parasite to survive, since it is the highway of the immune system, whereas the parasite is less easily destroyed when it is hiding out in the hepatocyte cells in the liver. It is also important to note that Plasmodium has a long evolutionary history, and may in some parts of its life cycle be constrained by physiological or life history characteristics of its evolutionary forebears, which may also contribute to our perception of the life cycle as being very complex!

Pathophysiology of Malaria

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QUESTION

What is the pathophysiology of malaria?

ANSWER

Malaria causes disease through a number of pathways, which depend to a certain extent on the species. Malaria is caused by a single-celled parasite of the genus Plasmodium; there are five species which infect humans, beingPlasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

All these species are introduced into the human blood stream through the bite of an infected mosquito; the life stage of malaria at this point is called a “sporozoite”, and they pass first to the liver, where they undergo an initial stage of replication (called “exo-erythrocytic replication”), before passing back into the blood and invading red blood cells (called “erythrocytes”, hence this is the “erythrocytic” part of the cycle). The malaria parasites that invade red blood cells are known as merozoites, and within the cell they replicate again, bursting out once they have completed a set number of divisions. It is this periodic rupturing of the red blood cells that causes most of the symptoms associated with malaria, as the host’s immune system responds to the waste products produced by the malaria parasites and the debris from the destroyed red blood cells. Different species of malaria rupture the red blood cells at different intervals, which leads to the diagnostic cycles of fever which characterise malaria; P. vivax, for example, tends to produce cycles of fever every two days, whereas P. malaria produces fever every three.

In addition, Plasmodium falciparum produces unique pathological effects, due to its manipulation of the host’s physiology. When it infects red blood cells, it makes them stick to the walls of tiny blood vessels deep within major organs, such as the kidneys, lungs, heart and brain. This is called “sequestration”, and results in reduced blood flow to these organs, causing the severe clinical symptoms associated with this infection, such as cerebral malaria.

More details on the exact biochemical mechanisms for sequestration and its effect on the pathology of the infection can be found on the Tulane University website.